Healthcare Provider Details

I. General information

NPI: 1477217842
Provider Name (Legal Business Name): PEIYU LIU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 CANAL ST
NEW YORK NY
10013-3599
US

IV. Provider business mailing address

268 CANAL ST
NEW YORK NY
10013-3599
US

V. Phone/Fax

Practice location:
  • Phone: 212-379-6996
  • Fax: 212-379-6935
Mailing address:
  • Phone: 212-379-6996
  • Fax: 212-379-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number828089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: